1649232570 NPI number — MRS. KIMBERLY SONKIN THRUSTON MOT OTRL CHT

Table of content: MRS. KIMBERLY SONKIN THRUSTON MOT OTRL CHT (NPI 1649232570)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649232570 NPI number — MRS. KIMBERLY SONKIN THRUSTON MOT OTRL CHT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
THRUSTON
Provider First Name:
KIMBERLY
Provider Middle Name:
SONKIN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MOT OTRL CHT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SONKIN
Provider Other First Name:
KIMBERLY
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1649232570
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/21/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1583
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHARLOTTESVILLE
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
22902-1583
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
434-982-7794
Provider Business Mailing Address Fax Number:
434-982-7752

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
410 ALBEMARLE SQ
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHARLOTTESVILLE
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
22901-7400
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
434-817-4278
Provider Business Practice Location Address Fax Number:
434-817-4279
Provider Enumeration Date:
04/05/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225XH1200X , with the licence number:  0119002963 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 010349087 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00377986 . This is a "MEDICARE PIN" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".




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